Mount Sinai P/D Surgery Achieves Zero Mortality in Mesothelioma Study

A new study from Mount Sinai Health System reports zero in-hospital and 30-day mortality for pleurectomy/decortication (P/D) in carefully selected people with pleural mesothelioma. The results directly challenge findings from the controversial MARS2 trial, which questioned whether surgery has a role in treating this disease.

Published in the February 2026 issue of the Annals of Thoracic Surgery, the study is led by Dr. Raja M. Flores, Chair of Thoracic Surgery at Mount Sinai. It presents data from one of the highest-volume mesothelioma surgical centers in the country.

Key Findings

The study, titled “Disaster on MARS2? Lessons Learned from Modern Day Outcomes,” reports outcomes from Mount Sinai’s experience with P/D, a lung-sparing surgical approach that removes tumor lining from the chest wall and lung surface while preserving the underlying lung.

Key results include:

• Zero perioperative mortality at both in-hospital and 30-day time points
• 4.2% mortality at 90 days, far below rates reported in the MARS2 trial
• Nearly 80% of surgical candidates had the epithelioid subtype, which tends to respond better to treatment
• Low overall complication rates attributed to rigorous patient selection

Why This Matters

Pleurectomy/decortication is a lung-sparing alternative to extrapleural pneumonectomy (EPP), which involves removing the entire lung along with surrounding tissue. P/D preserves the lung, typically resulting in shorter hospital stays, fewer complications, and better quality of life.

The MARS2 trial, published in 2024, reported concerning mortality rates for P/D and questioned whether surgery improved outcomes compared to chemotherapy alone. Those findings led some oncologists to reconsider surgical options for their patients.

Dr. Flores’ data suggests that the difference lies not in the surgery itself but in how candidates are selected and where the procedure is performed. Mount Sinai’s protocol emphasizes advanced imaging, thorough preoperative evaluation, and video-assisted thoracic surgery (VATS) techniques refined over two decades.

The Role of Patient Selection

The study underscores that not every person with mesothelioma is a candidate for surgery. Mount Sinai’s selection criteria focus on several factors:

• Histological subtype: Epithelioid tumors respond most favorably
• Disease stage: Earlier-stage disease with limited spread
• Overall fitness: Patients must tolerate the procedure safely
• Imaging and testing: CT, PET scans, and pulmonary function tests guide decisions

By concentrating on patients most likely to benefit, the team achieved outcomes that dramatically outperformed broader surgical cohorts.

Looking Ahead

Dr. Flores’ team is expanding their work to combine surgery with immunotherapy. Mount Sinai is pursuing clinical trials that pair P/D with checkpoint inhibitors, aiming to improve long-term survival beyond what surgery or drug therapy achieves alone.

The results reinforce that surgical treatment should remain part of the discussion for eligible people with mesothelioma, particularly at high-volume centers with dedicated thoracic oncology programs. For those considering treatment options, seeking evaluation at a center experienced in mesothelioma surgery is an important first step.